In August 2016, the Politburo Standing Committee announced the ambitious Healthy China 2030 initiative which calls for both comprehensive healthcare reform and societal participation to create a more health-conscious society. In this exploratory piece, Kirsten Lee Olson of Tractus Asia discusses the population health challenges that China is facing and how Healthy China 2030 plans to address them.

China’s evolving economy has produced unanticipated challenges in population health. In the 1990s, China’s healthcare system was developed to address infectious diseases and traumatic injuries which are the primary healthcare concerns of a developing economy. However, as China continues to develop, the country’s healthcare system has not been able to manage the growing rate of chronic and other non-communicable diseases often associated with developed economies. According to the World Health Organization, noncommunicable disease accounts for approximately 80 per cent of China’s current annual mortality rate and 70 per cent of its total disease burden.[1]

Part of this may be due to increased life expectancy – people are simply living long enough to develop chronic illnesses. However, the preponderance of chronic disease is due to environmental pollution and lifestyle choices such as diet, inadequate exercise, and tobacco and alcohol usage. Type 2 diabetes, historically found in developed economies, now effects over 110 million Chinese citizens with upwards of 50 per cent of Chinese adults classified as pre-diabetic. The annual cost of diabetes treatment exceeds Chinese yuan (CNY) 173.4 billion and contributes to 13 per cent of China’s total medical expenditures.[2] Clearly more investment in chronic disease prevention is needed.

Healthy China 2030Faced with this unsustainable situation, China released the Healthy China 2030 initiative in August 2016. It introduces plans for significant healthcare system reform, but also provides an integrative approach to population health that incorporates industry, environmental protection and individual accountability by means of social and market forces.

The Healthy China 2030 initiative’s plans for hospital organisation, the essential drugs list and foreign direct investment in healthcare have garnered the most attention in the press. Yet, previous campaigns have addressed similar reforms, such as the overhaul of social health insurance in 2014 and 2015. What is new in this initiative is the focus on environmental protection which brings a breath of fresh air to the topic, considering how long the central government has turned a blind eye to the correlation between pollution and disease. In 2017, major strides were made in environmental protection with 24.4 gigawatts of solar energy installed in the first six months alone.[3] What remains to be seen is how the central government will address the portion of the Healthy China 2030 initiative on individual accountability, a section which will require much needed changes in population behaviour.

Diet
China has two seemingly opposite dietary challenges—malnutrition and obesity. Healthy China 2030 hopes to address both issues through dietary education and by providing resources for nutritional management. However, the initiative does not go into any detail on how it plans to accomplish this goal.

In March 2017, the China Development Research Foundation shared the results of its six-year pilot nutrition programme. Eleven-year-olds who participated in the nutrition programme were on average six centimetres taller than the control group.[4] The programme provided a nutritionally balanced school lunch, valued at CNY 4/student, and supplemented insufficient nutrition at home. This pilot proved that a cost-effective nutrition programme is feasible, however the question still remains over whether a programme like this could be implemented on a national scale. In July 2016, the State Council announced its intention to address malnutrition by developing nutrition programmes for infants, pregnant women, students, the elderly, hospital patients and other at-risk groups.[5]

In contrast to malnutrition, which afflicts impoverished segments of China’s population, the part of the population affected by obesity has the income and resources to support a healthy diet, but lifestyle and low health literacy has led them to make poor dietary choices.

What Healthy China 2030 proposes to accomplish is nothing short of social engineering with the government’s goal being the transformation of China into a health-conscious society. Even though this goal is admirable, many questions as to how it can be implemented remain unanswered. This is an area where market as well as social forces will likely be employed.

ExerciseHealthy China 2030 wants to implement a national physical fitness test and physical health monitoring system. Encouraging exercise participation is difficult but doable, whereas testing and tracking activity on the national level tends to be more practical in theory than in reality.

To increase participation in physical activities, China plans to construct a series of free public sports facilities, community sports programmes and outdoor fitness amenities such as fitness trails and cycling paths. However, making these new facilities available is not the same as getting people engaged to use them.

One strategy the government is employing to motivate people is to popularise sports. Basketball and table tennis have long been popular in China, and interest in football is steadily on the rise. A recent push to increase participation in winter athletics to 300 million people by 2022—in anticipation of the Beijing Winter Olympics—likely played a part in the National Hockey League’s China debut in 2017. By initiating a mandatory hour of physical activity for all children enrolled in school the government hopes to encourage “sport-for-life”. These initiatives are a good start to get China’s population moving.

Tobacco and alcoholChina has 300 million smokers that make up approximately one third of the adult population, and consumes more cigarettes per annum than the next four countries combined. Each year 1 million deaths are directly attributed to tobacco usage and 100,000 deaths to second-hand smoke inhalation,[6] not including chronic disease associated with tobacco use.

The Healthy China 2030 initiative is very clear on how to reduce tobacco usage. Increased restrictions on public smoking will reduce opportunities to ‘light up’ and will decrease exposure to second-hand smoke. Education campaigns, price controls and higher taxes will all be employed to help discourage new smokers from picking up the habit. For those already addicted, the government plans to strengthen smoking cessation services.

While efforts to combat smoking seem straightforward, attempts at reducing the prevalence of alcoholism are not. The general perception among the Chinese population is that alcohol abuse is not a nationwide issue and as a result few studies have been conducted on the subject. What has been documented is the volume of alcohol sold, which has increased rapidly since 1980. A 2003 article published by the Medical Council on Alcohol found a 3.4 per cent overall occurrence of alcohol dependency among study participants. These results put China on par with Australia’s 3.5 per cent overall prevalence of alcohol dependency and makes alcoholism the country’s third most prevalent mental illness.[7]

The first step in substance abuse treatment is admitting you have a problem.[8] The Healthy China 2030 initiative is a lengthy document, yet it only dedicates two sentences to alcohol control. This shows that the central government shares the nation’s misperception of alcohol usage. China does not have enough medical alcohol treatment programmes to address the actual need. Informal support groups, like Alcoholics Anonymous, are foreign run and conducted in English which makes them inaccessible to many. Along with a lack of available resources, obstacles such as social pressure, perception and stigma may also play a role in preventing addicts from seeking treatment.

Opportunities for European companies
China’s health challenges are substantial, but not insurmountable. The Healthy China 2030 initiative is heading in the right direction; however, China will need more resources and expertise to achieve its population health goals. With these changes in healthcare, European non-governmental organisations and companies now have an opportunity to bring their experience in diet and fitness management to an increasingly receptive Chinese market.

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